SHM Converge Scientific Abstract ePoster Gallery-Surviving the Unsurvivable: 45-Year-Old Patient With Unoperated Tetralogy of Fallot

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This case describes a 45-year-old woman with an unrepaired tetralogy of Fallot (TOF) who presented with fever and fatigue and was found to have infective endocarditis caused by <em>Streptococcus parasanguinis</em>. Despite her congenital heart disease, she had normal oxygen saturation, blood pressure, and heart rate, with no cyanosis, suggesting unusually well-balanced hemodynamics. Echocardiography showed severe right ventricular hypertrophy, infundibular pulmonary obstruction, a large perimembranous ventricular septal defect, and mobile tricuspid valve vegetations.

Cardiothoracic surgeons recommended corrective TOF surgery, but treatment was limited by the patient’s lack of insurance, so she was treated for endocarditis and discharged with sparse outpatient follow-up.

The discussion emphasizes that untreated TOF is usually fatal early in life, with fewer than 2% of patients surviving beyond age 40. Survival depends largely on the degree of right ventricular outflow obstruction and right-to-left shunting. In this patient, infundibular stenosis likely helped maintain a balance between pulmonary and systemic blood flow, allowing her to survive into adulthood without surgery. However, untreated TOF typically progresses from right ventricular hypertrophy to right and then biventricular failure, and common causes of death include hypoxic spells, stroke, and brain abscess.

The report concludes that early surgical repair is critical for TOF, while older untreated patients present complex management challenges, especially when social barriers such as lack of insurance limit access to definitive care.

Asset Subtitle

Martha C. Lopez Siles

Meta Tag

Author List Martha C. Lopez Siles, Robin Horn

Category Clinical Vignettes

Concept Tetralogy of Fallot

Concept Ventricular Septal Defect

Concept Right Ventricular Outflow Tract Obstruction

Concept Early Surgical Repair

Concept Right Ventricular Hypertrophy

Distinguished Non-Finalist

Presenter Organization Christiana Care

Presenting Author Martha C. Lopez Siles

Track Adult

Keywords

tetralogy of Fallot

infective endocarditis

Streptococcus parasanguinis

right ventricular hypertrophy

infundibular pulmonary obstruction

ventricular septal defect

tricuspid valve vegetations

congenital heart disease

surgical repair

lack of insurance

Tetralogy of Fallot

Ventricular Septal Defect

Right Ventricular Outflow Tract Obstruction

Early Surgical Repair

Right Ventricular Hypertrophy